Evidenced-based nursing bridges research and practice

COLUMBIA, Mo.– On a scale of one to 10, the patient rated her pain “beyond 10.”

Maggie Van Loo and Cassie Wilbanks, nurses at the University of Missouri’s Ellis Fischel Cancer Center in Columbia, wondered if there was a better way.

The patient was in great pain from the dressings on her postoperative wound. The traditional way to dress wounds like hers was to apply wet gauze. When the gauze is dry, the dressing is removed, taking damaged tissue with it. It was a painful process that she had to undergo several times a day.

“We decided we wanted to investigate if there was something we could do differently,” said Van Loo.

Van Loo and Wilbanks used a process called evidence-based practice (EBP) to rethink their approach to wound care.

“The goal of evidence-based practice is to take information from the best research and resolve problems that the nurse sees in the clinical setting,” said Van Loo.

The sheer volume of research published each year is more than busy practitioners can keep up with. EBP helps practitioners find high-quality research that applies to specific problems or questions.

In EBP, an important part of getting the right answers is to ask the right questions. Van Loo and Wilbanks used a formula called “PICO,” which stands for Population, Intervention, Comparison and Outcome. The formula helps practitioners find research that addresses their problem, and offers potential solutions and ways to measure the effectiveness of those solutions.

The nurses learned how to critically review the research literature on their topic. They learned about different types of dressings from wound experts and got advice from other nurses and physicians.

They got good results with a type of dressing called hydrofiber, which protects wounds with a moist gel. The new dressing virtually eliminated their patient’s pain. While the hydrofiber dressing was more expensive, it didn’t have to be changed several times a day, so it was actually more cost effective than gauze. Applying the hydrofiber dressing was also easier.

“The patient was much happier,” said Wilbanks.

Van Loo and Wilbanks used the new dressing on other patients and carefully compared the outcomes with those of patients using gauze dressings. Van Loo said the whole process took about a year. They presented their findings to the hospital’s products committee, which approved the new dressing for general use.

They have been giving presentations on their work, sharing what they have learned about wound care but also offering their insights into the process of conducting an EBP project. They also developed a short video explaining how they went about the study.

They are also talking about their project this month at the seventh annual Evidence-Based Practice on the Frontline conference, hosted by MU Nursing Outreach.

The theme of this year’s EBP conference is “Building a Culture of Quality, Safety and Nursing Professionalism,” and the program will reflect the varied challenges nurses face integrating EBP in their workplaces, from interpreting research studies to dealing with colleagues who are reluctant to change the way they do things, says Shirley Farrah, assistant dean for outreach at MU’s Sinclair School of Nursing.

“Although evidence-based health care results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence-based best practices,” Farrah said. “It’s not because they don’t believe in it. They do. But there are many barriers, including resistance from colleagues, nurse leaders and managers.”

Van Loo says she encountered some resistance in her EBP project with Wilbanks. “I think it goes back to the way you were taught, and it takes a while to change the thought process because you’ve been doing that particular dressing that way for many years,” she said. “It’s slow and it just takes persistence in discussing the pros and cons.”

What: Evidence-Based Practice on the Frontline: Building a Culture of Quality, Safety and Nursing Professionalism

When: April 17, 2014

Where: Hilton Garden Inn, Columbia

Keynote speaker: Lynn Gallagher-Ford, director of the Center for Transdisciplinary Evidence-based Practice at Ohio State University’s College of Nursing